chronic mucocutaneous candidiasis

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infection by fungi of the genus Candida, generally C. albicans, most commonly involving the skin, oral mucosa (thrush), respiratory tract, or vagina; occasionally there is a systemic infection or endocarditis. It is most often associated with pregnancy, glycosuria, diabetes mellitus, or use of antibiotics. The Centers for Disease Control and Prevention has found that in the United States this condition is the fourth most common cause of nosocomial infections of the blood stream. Called also candidosis and moniliasis.

The most prominent symptom of vaginitis due to Candida infection is severe itching. Sexual transmission is unlikely. Intravaginal cream containing miconazole or clotrimazole, applied each night for one week, usually clears up the infection. Difficulty or pain with swallowing, or retrosternal pain, may indicate candidiasis of the esophagus. Systemic antifungal therapy is indicated for esophagitis and other more severe forms of the disease. Therapeutic options include ketoconazole, fluconazole, and amphotericin b. Chronic suppressive therapy is sometimes required for severely immunocompromised patients. The Infectious Disease Society of America has published “Practice Guidelines for the Treatment of Candidiasis” on their web site,
atrophic candidiasis oral candidiasis marked by erythematous, pebbled patches on the hard or soft palate, buccal mucosa, and dorsal surface of the tongue, a complication of numerous different conditions such as vitamin deficiency, diabetes mellitus, or poorly fitting dentures. There are acute forms and a chronic form called denture stomatitis.
bronchopulmonary candidiasis candidiasis of the respiratory tree, occurring in a mild afebrile form manifested as chronic bronchitis, and in a usually fatal form resembling tuberculosis. Called also bronchocandidiasis.
chronic mucocutaneous candidiasis a group comprising a number of varying forms of Candida infection, marked by chronic candidiasis of the skin and nails and the mucous membranes of the mouth and vagina that is resistant to treatment; it may be localized or diffuse, is sometimes familial, and may be associated with disorders of the immune and endocrine systems.
endocardial candidiasis Candida endocarditis.
oral candidiasis thrush.
pulmonary candidiasis a type of fungal pneumonia caused by infection with Candida species, seen especially in immunocompromised patients or those with malignancies. Called also Candida pneumonia.
vaginal candidiasis (vulvovaginal candidiasis) candidal infection of the vagina, and usually also the vulva, commonly characterized by itching, creamy white discharge, vulvar redness and swelling, and dyspareunia. Called also Candida or candidal vaginitis and Candida or candidal vulvovaginitis.

chronic mucocutaneous candidiasis

a heterogeneous group of disorders, unified by impaired cell-mediated immunity against Candida species; a rare form of candidiasis characterized by candidal infection lesions of the skin, mucous membranes, GI tract, and respiratory tract. This disease usually occurs during the first year of life or with immune system dysfunction but can develop at any time. It affects both males and females and may be associated with an inherited defect of the cell-mediated immune system that allows autoantibodies to develop against target organs. The humoral immune system functions normally in this disease. The onset of infections associated with the disease may precede endocrinopathy.
observations Chronic mucocutaneous candidiasis may affect the skin, the mucous membranes, the nails, and the vagina, usually causing large, circular lesions. Associated viral infections may lead to endocrinopathy and hepatitis. Infections of the mouth, nose, and palate may cause problems with speech and eating. Tetany and hypocalcemia are the most common symptoms associated with the endocrinopathy and are usually confined to the organ involved. Other complications associated with chronic mucocutaneous candidiasis may include diabetes, Addison's disease, hypothyroidism, and pernicious anemia. In some patients psychiatric problems develop as a result of disfigurements and extensive endocrinal disorders. Diagnosis of this disease usually includes laboratory tests, which commonly show a normal T cell count and normal immunological responses to antigens other than Candida albicans. The endocrinopathy associated with this disease may include nonimmunological aberrations, such as hypocalcemia, abnormal hepatic function, hyperglycemia, iron deficiency, and abnormal vitamin B12 absorption. Other immunodeficiency diseases associated with chronic Candida infection must be excluded by diagnosis. Such immunodeficiency diseases as DiGeorge's syndrome, ataxia-telangiectasia, and severe combined immunodeficiency disease all cause serious immunological defects. Required after diagnosis of chronic mucocutaneous candidiasis are evaluations of numerous physiological mechanisms, such as adrenal, gonadal, pancreatic, parathyroid, pituitary, and thyroid functions. Chronic mucocutaneous candidiasis is progressive and usually leads to endocrinopathy.
interventions Chronic mucocutaneous candidiasis resists treatment with topical antifungal agents, miconazole, and nystatin. Endocrinopathies associated with the disease must be treated individually by hormone replacement; some success in this regard has been reported with experimental injections of thymosin and levamisole. Most success in treating severe cases has been achieved with transfer factor from a Candida-positive donor, with IV amphotericin B. Some success against systemic infection may also be possible with amphotericin B, but that agent is highly nephrotoxic. Some patients respond fairly well to fetal thymus transplantation. Plastic surgery may aid patients in coping with disfigurements caused by the disease. Treatment may also include oral or intramuscular iron replacement.
nursing considerations Patients with chronic mucocutaneous candidiasis must be closely monitored for signs of other associated diseases, such as Addison's disease, diabetes, hepatitis, and pernicious anemia. Patients suffering psychologically from disfigurements associated with the disease often respond positively to the counsel, encouragement, and kindness of the nursing staff. Amphotericin B, a nephrotoxin, is involved in the treatment. Therefore the patient must be carefully monitored for renal function. Patients benefit from calm explanations of the progressive manifestations of the disease and the importance of regular endocrinological checkups.
References in periodicals archive ?
An immune defect causing dominant chronic mucocutaneous candidiasis and thyroid disease maps to chromosome 2p in a single family.
The syndrome of chronic mucocutaneous candidiasis with selective antibody deficiency.

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